MEDICARE: NATALIE KOREN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN 16906	FL

General Provider Information

NPI Number	:	1003824145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE KOREN D.D.S.

Provider Business Mailing Address
First Line	:	3112 N.FEDERAL HIGHWAY
Second Line	:
City	:	LIGHTHOUSE PIONT
State	:	FL
Zip	:	33064
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3112 N FEDERAL HWY
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-6738
Country	:	US
Telephone Number	:	954-580-2200
Fax Number	:	954-580-2203

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/28/2007

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